Study Shows Checklists May Not Reduce Incidence of Surgical Errors

New research published in the New England Journal of Medicine reveals that checklists fail to reduce the number of surgical errors in hospital operating rooms. These surgical checklists are often relied upon as a means to diminish the possibility of so-called “never” events – mistakes such as wrong site or wrong patient surgery that often carry catastrophic outcomes for the patient.

Prior studies on the effectiveness of such pre- and post-operative checklists suggested that they could reduce the number of surgery complications by an estimated 31 percent. The results were published in a 2010 issue of the same medical journal, but these recent findings imply that such measures may not be as useful as researchers had formerly believed.

Checklists may not impact rate of surgical errors

The research was conducted within acute care hospitals in Ontario, Canada both before and after surgical safety checklists were implemented.  Researchers examined the outcomes of more than 200,000 procedures before these checklists were applied and some three months afterward. Among the outcomes analyzed were the rate of surgery complications, duration of hospital stay, rates of hospital readmission and ER visits along with incidence of mortality. Researchers anticipated that safety checklists would lead to better overall patient outcomes and lower mortality rates.

However, the data showed that rates of patient mortality during their hospital stay and within one month following their procedure remained the same after the checklists were put into practice. The risk of death dropped from 0.71% before checklist implementation to 0.65% – a drop so insignificant that no real benefits were realized.

The researchers concluded that “implementation of surgical safety checklists in Ontario, Canada, was not associated with significant reductions in operative mortality or complications.”

These results are not in line with those published in the British Medical Journal back in 2011. During this study, researchers determined that safety surgical checklists did reduce mortality rates following surgery. After analyzing the outcomes of elderly patients being treated within intensive care units (ICUs),  the study authors found that post-op mortality rates dropped 10 percent compared to facilities that did not employ checklists.

Surgery “never” events occur up to 4,000 times each year

Surgical never events are classified as the type which should never occur, but surprisingly these shocking blunders take place thousands of times every year, according to Johns Hopkins patient safety researchers. This medical malpractice study estimated that roughly 39 times each week, a U.S. surgeon leaves a foreign object inside the patient during an operation.  Whether a sponge, an instrument or gauze, this type of never event accounts for dozens of malpractice claims that are filed annually.

Even more alarming, Johns Hopkins researchers say that surgeons are likely to perform the wrong procedure at least 20 times a week, and operate on the wrong body part 20 times a week. These culminate in over 4,000 grave surgical errors every year, and shed light on the magnitude of this problem and inherent risks for patients.

While checklists may help lower the chances of adverse outcomes and complications, hospitals need to adhere to more rigorous reporting systems to enhance safety efforts, notes the study’s lead author Marty Makary, M.D., M.P.H.

In the course of their study, Dr. Makary and his team found that most of these never surgical events happened in patients aged between 40 and 49. Doctors in this same age bracket of 40-49 were responsible for more than one-third of these surgical errors.